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. 2018 Dec;70 Suppl 3(Suppl 3):S347-S352.
doi: 10.1016/j.ihj.2018.09.012. Epub 2018 Oct 6.

Transcatheter aortic valve replacement in India-Early experience, challenges, and outcomes from a single center

Sengottuvelu Gunasekaran  1 , Muthukumaran C Sivaprakasam  2 , Vinodh Kumar PaulPandi  3 , Abraham Oomman  3 , Asha Mahilmaran  3 , Mathew Samuel Kalarickal  3 , Vijay Shankar Sadhasivam  4 , Ganapathy Arumugam Chandrasekaran  5 , Srinivasan Kanthallu Narayanamoorthy  3 , Pramod Kumar Karaimbil Puthukavi  3 , Sathyamurthy Immaneni  3 , Rajeshwari Nayak  3 , Louis Felix Sridhar  4 , Paul Jude Ramesh Thangaraj  4 , Sunder Thirugnanasambandan  4 , Yusuf Meerangham Mohammed  4 , Dheeraj Reddy  4 , Dilip Kumar Mishra  4 , Girinath Malligayil Ramakrishna  4
Affiliations

Transcatheter aortic valve replacement in India-Early experience, challenges, and outcomes from a single center

Sengottuvelu Gunasekaran et al. Indian Heart J. 2018 Dec.

Abstract

Background: Despite the increasing popularity of transcatheter aortic valve replacement (TAVR), only about 10,000 TAVR cases have been performed in Asia to date. The procedure is still in a nascent stage in India with very few centers offering this state-of-art technique. Here, we present the early results of TAVR experience at our center.

Methods: Forty-nine patients with severe symptomatic aortic stenosis (AS) were referred to our center for TAVR from November 2015 to February 2018. Twenty-five patients underwent TAVR at our conventional cardiac catheterization laboratory under local or general anesthesia, with standby surgical team support.

Results: The mean age of the patients was 72.0 ± 8.1 years. The mean Society of Thoracic Surgeons score was 13.8 ± 10.2. Baseline mean ejection fraction was 50.3 ± 14.8%. Baseline mean aortic valve gradient was 55.8 ± 24.7 mmHg. There was one procedural-related death. Two of the patients required urgent surgery: one for contained annular rupture and one underwent vascular repair for femoral artery occlusion. Mild and moderate paravalvular leak was seen in 11 and 3 patients, respectively. Four patients (16%) required permanent pacemaker. Eighty percent were in New York Heart Association class I-II at discharge. One-year all-cause mortality was 8%, with no hospitalizations or major adverse cardiac event during the 1-year follow-up.

Conclusion: Our early data clearly shows that in our country, TAVR is a good alternative for symptomatic severe AS for high surgical risk cases. Large-scale multicenter studies are required to study the real impact of TAVR in the Indian scenario. During initial years of implementation of a nationwide TAVR program, it may be prudent to focus on creating TAVR Centers of Excellence by developing an ideal hub and spokes model.

Keywords: Aortic stenosis; Indian experience; Transcatheter aortic valve replacement (TAVR).

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Figures

Fig. 1
Fig. 1
Dyspnea grade during follow-up period as compared with the baseline. Postprocedure period there was significant improvement in dyspnea, which maintained on 1-year follow-up.
Fig. 2
Fig. 2
Paravalvular leak (PVL) grade during follow-up period as compared with the baseline. Immediate postprocedure moderate PVL was seen in 3 patients, and 11 patients had mild PVL. All PVL disappeared by the end of 1 year.
Fig. 3
Fig. 3
Aortic valve (AV) mean gradient ± 2 SD, at the baseline and during 1-year follow-up. Baseline mean gradient was 55.8 ± 24.7  mmHg. Immediate postprocedure mean gradient was 8.5 ± 4.9  mmHg. One-month mean gradient was 8.8 ± 3.6  mmHg. Six-month mean gradient was 8.3 ± 2.8  mmHg. One-year mean gradient was 8 ± 3.5  mmHg. SD, standard deviation.
Fig. 4
Fig. 4
Mean ejection fraction (EF) ± 2 SD, at the baseline and during 1-year follow-up. Baseline mean EF was 50.3 ± 14.8%. Immediate postprocedure mean EF was 55.4 ± 9.6%. The 1-month, 6-month, and 1-year mean EF are almost equal. SD, standard deviation.
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